Medical Director, Utilization Management

This is a fully remote position, open to applicants in United States.

📋 Description

• Assist the clinical content team in evaluating the company's clinical decision guidelines and evidence-based literature.

• Offer expert insights on content aimed at influencing physicians in medical care to enhance patient outcomes.

• Deliver timely medical reviews that adhere to quality and timeliness standards.

• Make clinical determinations utilizing evidence-based criteria, clinical judgment, medical society guidelines, and relevant literature.

• Record communication and decision-making processes in Cohere workflow tools.

• Utilize appropriate templates for documenting medical necessity decisions during case evaluations.

• Engage in peer-to-peer discussions with treating providers to clarify clinical details and explain review results.

• Provide recommendations on alternative treatments based on medical necessity criteria and evidence-based research.

• Exhibit professionalism, accountability, and service in interactions with colleagues and providers.

• Contribute to projects that enhance the team’s clinical expertise and operational efficiency.

• Support improvements in operations and the member/provider experience related to clinical review tasks.

⛳️ Requirements

• Completion of a US-based residency program and fellowship in Internal Medicine.

• Board certification as an MD or DO.

• Current unrestricted state license to practice medicine; reviewers must maintain necessary credentials for the role.

• Over 5 years of clinical practice following residency/fellowship in Internal Medicine.

• Ability to thrive in a matrix organization.

• Proficient with technology and eager to learn new software tools.

• Familiarity with the managed care regulatory framework and processes.

• Detail-oriented, adaptable, and capable of working independently with minimal supervision.

• At least 1 year of managed care utilization review experience is preferred.

• Membership in national and/or regional specialty societies is a plus.

• Licensure in AZ, GA, MS, NC, ND, OK, OR, or TX is highly desirable.

• Willingness to acquire additional state licenses with support from Cohere.

🏝️ Benefits

• Fully remote position with approximately 10% travel required.

• Comprehensive medical, dental, vision, life, disability insurance, and Employee Assistance Program.

• 401K retirement plan with company matching contributions.

• Flexible spending and health savings accounts available.

• Flex Time Off alongside company holidays.

• Up to 14 weeks of paid parental leave.

• Pet insurance options available.

• Bonus included in the total benefits package.